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Electronic Memorandum Decreases Unnecessary Antimicrobial Use for Asymptomatic Bacteriuria and Culture-Negative Pyuria

Published online by Cambridge University Press:  02 January 2015

Leslie A. Linares ,
David J. Thornton ,
Judith Strymish ,
Errol Baker  and
Kalpana Gupta
Leslie A. Linares
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
David J. Thornton
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
Judith Strymish
Affiliation:
Boston University School of Medicine, Boston, Massachusetts Harvard Medical School, Boston, Massachusetts
Errol Baker
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts
Kalpana Gupta*
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
*
VA Boston HCS, 1400 VFW Parkway, 111 Med, West Roxbury, MA 02132 ([email protected])
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Abstract

Objectives.

Asymptomatic bacteriuria/candidiuria (ASB) and culture-negative pyuria (CNP) are common and often result in inappropriate antibiotic use. We aimed to evaluate whether a standardized educational memorandum could reduce antimicrobial utilization for ASB/CNP.

Design, Setting, and Patients.

Quasi-experimental study with a control group, from a convenience sample of inpatients with abnormal urinalysis or urine culture results in a Veterans Affairs hospital.

Intervention.

An educational memorandum outlining guidelines for diagnosis and treatment of ASB was placed in the chart of patients with ASB/CNP who were receiving antimicrobials.

Methods.

The records of patients meeting inclusion criteria were abstracted for demographics, comorbidities, antimicrobials, and symptoms suggestive of possible urinary tract infection (UTI). Patients were categorized as having ASB, CNP, or UTI. The number of antimicrobial-days attributed to ASB/CNP was compared between the control group and the intervention group.

Results.

Charts of 301 patients with abnormal urine results were reviewed. Thirty of 117 (26%) patients in the control group received antimicrobials for ASB/CNP for an average of 6.3 days. In the intervention group, 24 of 92 (26%) patients received antimicrobials for ASB/CNP for an average of 2.2 days (t-test: P<.001). Adverse events from antimicrobials for ASB/CNP occurred in 3 of the 30 (10%) patients in the control group. There were no adverse events from untreated ASB/CNP in the intervention group.

Conclusions.

ASB and CNP resulted in antimicrobial exposure in more than one-quarter of our study patients. Placing a standardized memorandum in the electronic record was associated with a 65% relative reduction in antimicrobial-days for ASB and CNP.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 7 , July 2011 , pp. 644 - 648
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Davey, P, Brown, E, Fenelon, L, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2005(4):CD003543.Google ScholarPubMed
2.Nicolle, LE, Bradley, S, Colgan, R, Rice, JC, Schaeffer, A, Hooton, TM. Infectious Disease Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40(5):643–654.CrossRefGoogle Scholar
3.US Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: US Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2008;149(1):43–47.Google Scholar
4.Hooton, TM, Bradley, SF, Cardenas, DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis 2010;50(5):625–663.Google Scholar
5.Pappas, PG, Kauffman, CA, Andes, D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;48(5):503–535.CrossRefGoogle ScholarPubMed
6.Cope, M, Cevallos, ME, Cadle, RM, Darouiche, RO, Musher, DM, Trautner, BW. Inappropriate treatment of catheter-associated asymptomatic bacteriuria in a tertiary care hospital. Clin Infect Dis 2009;48(9):1182–1188.Google Scholar
7.Gandhi, T, Flanders, SA, Markovitz, E, Saint, S, Kaul, D. Importance of urinary tract infection to antibiotic use among hospitalized patients. Infect Control Hosp Epidemiol 2009;30(2):193–195.CrossRefGoogle ScholarPubMed
8.Schwartz, DN, Abiad, H, DeMarais, PL, et al. An educational intervention to improve antimicrobial use in hospital-based long-term care facility. J Am Geriatr Soc 2007;55(8):1236–1242.Google Scholar
9.Zabarsky, TF, Sethi, AK, Donskey, CJ. Sustained reduction in inappropriate treatment of asymptomatic bacteriuria in a long-term care facility through an educational intervention. Am J Infect Control 2008;36(7):476–480.Google Scholar
10.Samore, MH, Bateman, K, Alder, SC, et al. Clinical decision support and appropriateness of antimicrobial prescribing. JAMA 2005;294(18):2305–2314.Google Scholar
11.Cornia, PB, Amory, JK, Fraser, S, Saint, S, Lipsky, BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients. Am J Med 2003;114(5):404–407.Google Scholar
12.Juthani-Mehta, M, Quagliarello, V, Perrelli, E, Towle, V, Van Ness, PH, Tineti, M. Clinical features to identify urinary tract infection in nursing home residents: a cohort study. J Am Geriatr Soc 2009;57(6):963–970.Google Scholar
13.Borenstein, M, Rothstein, H, Cohen, J. Power and precision. Englewood, NJ, Biostat. 2004.Google Scholar
14.Nicolle, LE. Asymptomatic bacteriuria: when to screen and when to treat. Infect Dis Clin North Am 2003;17:364–394.CrossRefGoogle ScholarPubMed
15.Bakke, A, Digranes, A. Bacteriuria in patients treated with clean intermittent catheterization. Scand J Infect Dis 1991;23(5):577–582.Google Scholar
16.Ribera, MC, Pascual, R, Orozco, D, Perez Barba, C, Pedrera, V, Gil, V. Incidence and risk factors associated with urinary tract infection in diabetic patients with and without asymptomatic bacteriuria. Eur J Clin Microbiol Infect Dis 2006;25(6):389–393.CrossRefGoogle ScholarPubMed
17.Abrutyn, E, Mossey, J, Berlin, JA, et al. Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women? Ann Intern Med 1994;120(10):827–833.Google Scholar
18.Sobel, JD, Kauffman, CA, McKinsey, D, et al. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. Clin Infect Dis 2000;30(1):19–24.CrossRefGoogle ScholarPubMed
19.Harding, GK, Zhanel, GG, Nicolle, LE, Cheang, M. Antimicrobial treatment in diabetic women with asymptomatic bacteriuria. N Engl J Med 2002;347(20):1576–1583.Google Scholar
20.Saint, S, Meddings, JA, Calfee, D, Kowalski, CP, Krein, SL. Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med 2009;150(12):877–884.Google Scholar
21.Strom, B, Schinnar, R, Aberra, F, et al. Unintended effects of a computerized physician order entry nearly hard-stop alert to prevent a drug interaction. Arch Intern Med 2010;170(17):1578–1583.Google Scholar
22.Harris, AD, Lautenbach, E, Perencevich, E. A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance. Clin Infect Dis 2005;41(1):77–82.Google Scholar